Magnet Friederike Sophie, Bleichroth Hannah, Huttmann Sophie Emilia, Callegari Jens, Schwarz Sarah Bettina, Schmoor Claudia, Windisch Wolfram, Storre Jan Hendrik
1Cologne Merheim Hospital, Department of Pneumology, Faculty of Health/School of Medicine, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, 51109 Germany.
Department of General, Visceral and Vascular Surgery, St.-Josefs-Hospital Freiburg, Freiburg im Breisgau, 79104 Germany.
J Intensive Care. 2018 Oct 16;6:67. doi: 10.1186/s40560-018-0338-0. eCollection 2018.
Patients who require a prolonged weaning process comprise a highly heterogeneous group of patients amongst whom the outcome differs significantly. The present study aimed to identify the factors that predict whether the outcome for prolonged weaning will be successful or unsuccessful.
Data from tracheotomised patients who underwent prolonged weaning on a specialised weaning unit were assessed retrospectively via an electronic and paper-bound patient chart. Factors for weaning success were analysed by univariate and multivariate analyses.
Out of the 124 patients examined, 48.4% were successfully weaned ( = 60). Univariate analysis revealed that long-term home mechanical ventilation prior to current weaning episode; time between intubation and the first spontaneous breathing trial (SBT); time between intubation and the first SBT of less than 30 days; lower PaCO prior to, and at the end of, the first SBT; and lower pH values at the end of the first SBT were predictors for successful weaning. Following multivariate analysis, the absence of home mechanical ventilation prior to admission, a maximum time period of 30 days between intubation and the first SBT, and a non-hypercapnic PaCO value at the end of the first SBT were predictive of successful weaning.
The current analysis demonstrates that the evidence for respiratory insufficiency type II provided by clinical findings serves as a predictor of weaning failure.
需要长期撤机过程的患者构成了一个高度异质性的群体，他们的预后差异很大。本研究旨在确定预测长期撤机结果是成功还是失败的因素。
通过电子和纸质病历对在专门的撤机单元接受长期撤机的气管切开患者的数据进行回顾性评估。通过单因素和多因素分析来分析撤机成功的因素。
在124例接受检查的患者中，48.4%成功撤机（n = 60）。单因素分析显示，当前撤机前长期家庭机械通气；插管与首次自主呼吸试验（SBT）之间的时间；插管与首次SBT之间的时间少于30天；首次SBT前及结束时较低的动脉血二氧化碳分压（PaCO）；以及首次SBT结束时较低的pH值是成功撤机的预测因素。多因素分析后，入院前无家庭机械通气、插管与首次SBT之间的最长时间为30天、首次SBT结束时非高碳酸血症性PaCO值可预测撤机成功。
目前的分析表明，临床发现提供的II型呼吸功能不全证据可作为撤机失败的预测指标。
